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May also be co- prescribed with paracetamol for additional pain relief

xx

xx

Naproxen

Tablets 250mg, 500mg

Hospital only

Paracetamol

Injection 10mg/ml

Only for those patients where the oral route cannot be used

Prescribing notes

Aspirin and paracetamol have similar efficacy but paracetamol has no anti-inflammatory effect. Paracetamol does not cause gastritis/peptic ulceration.

Paracetamol injection is available to treat postoperative pain in selected patients only where the oral route is unavailable (see local treatment protocol).

Paracetamol overdose - new simplified guidance has been issued. All patients with a timed plasma paracetamol level on or above a single treatment line joining points of 100mg/L at 4 hours and 15mg/L at 15 hours after ingestion, should receive acetylcysteine (Parvolex® or generics), based on a new treatment nomogram, regardless of risk factors. For more details, see Drug Safety Update, September 2012. Treatment with acteylcysteine beyond 21 hours may be necessary depending on clinical evaluation of the individual patient. See Drug Safety Update, January 2017

A new weight-based dosing table and a technical information leaflet to help calculate the dose of acetylcysteine infusions to minimise the risk of dosing errors are available to download here.

Ibuprofen is useful for pain associated with inflammation, it is widely used for postoperative pain.

Step 2 (moderate pain)

Compound analgesic preparations

1st line

Co-codamol (codeine/paracetamol)

Tablets 8/500, 30/500 Capsules 8/500, 30/500 only

Consider prescribing paracetamol and codeine separately, see below.

2nd line

Co-dydramol (dihydrocodeine/ paracetamol)

Tablets 10/500

xx

xx

Co-codamol (codeine/paracetamol)

Dispersible tablets 8/500, 30/500

High sodium content reserve use for swallowing difficulty only, avoid use in renal impairment

Prescribing notes

Consider prescribing codeine and paracetamol separately for greater flexibility of dosing and titration to pain.

Co-codamol 8/500 paracetamol with low dose opioid is commonly used but the advantages over paracetamol alone have not been substantiated.

Co-codamol 30/500 has a higher dose of codeine and can cause severe constipation. Consider prescribing a laxative.

Co-dydramol is available in different strengths, 10mg/500mg, 20mg/500mg and 30mg/500mg. When prescribing, clearly indicate the tablet strength and dose.

On this website you will now see four icons for these resources rather than two. Please use BNF Legacy or BNF for Children Legacy as these will take you to the original format of the online publications which do not have any errors or omissions.